Management of Patients After Coronary Intervention for NSTEMI
After coronary intervention for a Non-ST Elevation Myocardial Infarction (NSTEMI) patient who was started on "Chico Grillo" (likely a medication name), aspirin is the additional medication needed to complete the dual antiplatelet therapy regimen.
Antiplatelet Therapy Requirements After NSTEMI PCI
- Aspirin should be administered to all NSTEMI patients without contraindications at an initial oral loading dose of 150-300 mg (or 75-250 mg IV), and at a maintenance dose of 75-100 mg daily long-term 1
- Following PCI for NSTE-ACS, dual antiplatelet therapy (DAPT) consisting of a P2Y12 receptor inhibitor in addition to aspirin is generally recommended for 12 months, irrespective of the stent type 1
- The American College of Cardiology recommends administering aspirin as soon as possible after hospital presentation and continuing indefinitely in patients who tolerate it 2
P2Y12 Inhibitor Options
- For NSTE-ACS patients, DAPT including aspirin and a potent P2Y12 receptor inhibitor (prasugrel or ticagrelor) is recommended 1
- Clopidogrel should only be used when prasugrel or ticagrelor are not available or are contraindicated 1
- The recommended loading dose for clopidogrel is 600 mg followed by 75 mg daily maintenance dose 1, 3
Duration of Therapy
- DAPT should be maintained for 12 months in patients treated with coronary stents following NSTEMI 1
- In specific clinical scenarios, this standard DAPT duration can be shortened (<12 months) or extended (>12 months) based on individual bleeding and thrombotic risks 1, 4
- Prolonged DAPT beyond 12 months may be considered after careful evaluation of the patient's thrombotic and bleeding risks 4, 5
Special Considerations
- For patients unable to take aspirin, a P2Y12 inhibitor (clopidogrel, prasugrel in PCI-treated patients, or ticagrelor) can be used as monotherapy 1, 2
- Patients at high risk of bleeding may benefit from shorter DAPT duration, while those at high ischemic risk may benefit from prolonged therapy 4, 5
- Avoid using two concurrent P2Y12 receptor inhibitors simultaneously 2
Common Pitfalls to Avoid
- Inappropriate use of prasugrel in contraindicated populations (prior stroke/TIA, elderly ≥75 years, low body weight <60 kg) 2
- Crossover between anticoagulants should be avoided (especially between UFH and LMWH), with the exception of adding UFH to fondaparinux when a patient proceeds to PCI 1
- Patients stopping DAPT early tend to be older, female, have prior cardiovascular disease, and have renal dysfunction, and may benefit from more intensive monitoring 5
In summary, aspirin is the essential additional medication needed for a patient who has undergone coronary intervention for NSTEMI and is already on a P2Y12 inhibitor (which appears to be referred to as "Chico Grillo" in the question). The combination of aspirin and a P2Y12 inhibitor forms the cornerstone of dual antiplatelet therapy that is critical for preventing stent thrombosis and recurrent ischemic events.